pentostatin: clinical use

Prescribing considerations

• Restrict use to clinicians experienced in cytotoxic chemotherapy.
• Control infection before starting or resuming treatment.
• Use caution with abnormal liver function or poor performance status.
• Discuss contraception and fertility preservation before treatment.
• Withhold for severe rash; withhold or discontinue if nervous-system toxicity develops.

Contraindications and cautions

• Hypersensitivity to pentostatin or any excipient, including mannitol
• Creatinine clearance below 60 mL/min
• Active infection

Monitoring

• Full blood count, with particularly frequent assessment early in treatment
• Serum creatinine, creatinine clearance and urea before administration and during therapy
• Blood chemistry and liver-function tests
• Clinical assessment for infection, rash, pulmonary toxicity and neurological toxicity
• Peripheral blood hairy-cell assessment; bone-marrow examination when clinically required to assess disease response

Clinical pharmacology

Pentostatin is a potent adenosine deaminase inhibitor with additional effects on RNA synthesis and DNA damage. Protein binding is low, and elimination is predominantly renal, making kidney function a major determinant of clearance.

Formulation and product differences

• The selected product is a white to off-white powder for intravenous injection or infusion after reconstitution.
• It contains mannitol, with sodium hydroxide or hydrochloric acid for pH adjustment, and is essentially sodium-free.
• Preparation requires cytotoxic-handling precautions and inspection for particles or discolouration; acidic solutions should be avoided.

Solution for infusion

Route: Intravenous

Strengths: 10 mg